Effects of different surgical treatments on pain, disability, anxiety and quality of life in lumbar disc herniation.

OBJECTIVE: This study aims to compare the effects of microscopic microdiscectomy and microendoscopic discectomy on pain, disability, fear of falling, kinesiophobia, anxiety, quality of life in patients with lumbar disc herniation (LDH). METHODS: A total of 90 patients who underwent microscopic microdiscectomy (n = 40) and microendoscopic discectomy (n = 50) for LDH were included in this study. The patients' pain, disability, fear of falling, kinesiophobia, anxiety, and quality of life were evaluated before the surgery, in the early postoperative period and three months after. RESULTS: In patients who underwent microendoscopic discectomy, the results of pain, disability, fear of falling, kinesiophobia and anxiety were statistically decreased compared with the microscopic microdiscectomy in the early postoperative period and three months later (p < 0.05). Also, a statistically higher increase was observed in the general health perception of patients who underwent microendoscopic discectomy three months after the operation (p < 0.01). CONCLUSION: Microendoscopic microdiscectomy, remains the most effective and widely applied method with advantages on pain, quality of life, and improved physical functions.

OBJETIVO: Este estudio tiene como objetivo comparar los efectos de la microdiscectomía microscópica y la discectomía microendoscópica sobre el dolor, la discapacidad, el miedo a caer, la kinesiofobia, la ansiedad y la calidad de vida en pacientes con hernia de disco lumbar (LDH). MÉTODOS: Se incluyeron en este estudio un total de 90 pacientes sometidos a microdiscectomía microscópica (n = 40) y discectomía microendoscópica (n = 50) por LDH. Se evaluó el dolor, la discapacidad, el miedo a caer, la kinesiofobia, la ansiedad y la calidad de vida de los pacientes antes de la cirugía, en el postoperatorio temprano y tres meses después. RESULTADOS: En los pacientes sometidos a discectomía microendoscópica, los resultados de dolor, discapacidad, miedo a caer, kinesiofobia y ansiedad disminuyeron estadísticamente en comparación con la microdiscectomía microscópica en el postoperatorio temprano y tres meses después (p < 0.05). Además, se observó un aumento estadísticamente mayor en la percepción de salud general de los pacientes sometidos a discectomía microendoscópica tres meses después de la operación (p < 0.01). CONCLUSIÓN: La microdiscectomía microendoscópica sigue siendo el método más eficaz y ampliamente aplicado con ventajas sobre el dolor, la calidad de vida y la mejora de las funciones físicas.

Discectomía simple y discectomía más fusión con discos de polimetilmetacrilato para el tratamiento de la hernia discal cervical / Simple discectomy and discectomy plus fusion with polymethylmethacrylate discs for the treatment of cervical herniated disc

Objetivo: Comparar los resultados entre la discectomía más fusión con injertos dediscos de polimetilmetacrilato y la discectomía simple para el tratamiento quirúrgico de la hernia discal cervical.Métodos: Se realizó un estudio caso-control. Se conformaron dos grupos con pacientes operados por hernia discal cervical. En el grupo I (estudio) se incluyeron 131 pacientesa los que se les realizó discectomía más fusión con discos de polimetilmetacrilato en el período entre enero de 2007 y diciembre de 2017. En el grupo II (control histórico), se incluyeron 131 pacientes a los que se les realizó discectomía simple en el períodocomprendido entre enero de 1996 y diciembre de 2006. Todos fueron intervenidos en el Hospital General Docente “Roberto Rodríguez Fernández”, de Morón, Ciego de Ávila,en el mismo quirófano, con las mismas disponibilidades tecnológicas y por el mismo cirujano principal. A todos los enfermos se les realizó el diagnóstico imagenológico con resonancia magnética; el dolor fue evaluado en el pre- y posoperatorio a través de laEscala Visual Análoga, y los resultados se categorizaron de acuerdo con la escala de Ebelin. Para el análisis de los datos se utilizó la técnica de independencia basada en la distribución de Chi-cuadrado para determinar la presencia de asociación estadísticaentre variables categóricas y, además, se aplicó la prueba de Kolmogorov-Smirnov para comparar las distribuciones de las dos muestras.Resultados: Las manifestaciones radiculares predominaron en ambos grupos, 85,5 (Por ciento) en el grupo I y 83,97 (Por ciento) en el grupo II. En el grupo I predominó la afectación de dos omás espacios, mientras que en el grupo II predominó la afectación de un solo espacio...(AU)

Introduction: To compare the results between discectomy plus fusion withpolymethylmethacrylate disc grafts and simple discectomy for the surgical treatment of cervical disc herniation.Methods: A case-control study was carried out. Two groups were formed with patients operated on for cervical disc herniation. Group I (study) included 131 patients who underwent discectomy plus fusion with polymethylmethacrylate discs from January 2007 to December 2017. In group II (historical control), 131 patients were included.They had undergone simple discectomy from January 1996 to December 2006. All of them were operated on at Roberto Rodríguez Fernández Teaching General Hospital in Morón, Ciego de Ávila, in the same operating room, with the same technological availabilities and by the same principal surgeon. All patients were diagnosed with magnetic resonance imaging; the pain was evaluated in the pre- and postoperativeperiod through the Visual Analogue Scale, and the results were categorized according to Ebelin scale. For data analysis, the independence technique based on Chi-square distribution was used to determine the presence of statistical association betweencategorical variables and, in addition, Kolmogorov-Smirnov test was applied tocompare the distributions of the two samples.Results: The radicular manifestations predominated in both groups, 85.5 (Per cent) in group I and 83.97 (Per cent) in group II. In-group I, the involvement of two or more spaces predominated, while in-group II the involvement of only one space predominated....(AU)

Unilateral mydriasis: a complication of spine surgery in prone position / Midríase unilateral: uma complicação da cirurgia de coluna em decúbito ventral

Abstract Prone position though is commonly used for better access to surgical site, but may be associated with a variety of complications. Perioperative Visual Disturbances or loss is rare but a devastating complication that is primarily associated with spine surgeries in prone position. In this case we report a 42 year old ASA-II patient who developed anisocoria with left pupillary dilatation following lumbar microdiscectomy in prone position. Following further evaluation of the patient, segmental pupillary palsy of the left pupillary muscles was found to be the possible cause of anisocoria. Anisocoria partially improved but persisted till follow up.

Resumo O posicionamento em decúbito ventral, embora comumente usado para melhorar o acesso ao local cirúrgico, pode estar associado a uma variedade de complicações. Distúrbios ou perda visual no Perioperatório é uma complicação rara, mas devastadora, que está principalmente associada à cirurgia de coluna vertebral em decúbito ventral. Relatamos aqui o caso de um paciente de 42 anos de idade, ASA - II, que desenvolveu anisocoria com dilatação pupilar esquerda após microdiscetomia lombar em decúbito ventral. Após uma avaliação adicional do paciente, observamos que a paralisia segmentar dos músculos pupilares esquerdos seria a possível causa de anisocoria. A anisocoria melhorou parcialmente, mas persistiu até o acompanhamento.

[Unilateral mydriasis: a complication of spine surgery in prone position]. / Midríase unilateral: uma complicação da cirurgia de coluna em decúbito ventral.

Prone position is commonly used for better access to surgical site, but may be associated with a variety of complications. Perioperative Visual Disturbances or loss is rare but a devastating complication that is primarily associated with spine surgeries in prone position. In this case we report a 42 year old ASA-II patient who developed anisocoria with left pupillary dilatation following lumbar microdiscectomy in prone position. Following further evaluation of the patient, segmental pupillary palsy of the left pupillary muscles was found to be the possible because of anisocoria. Anisocoria partially improved but persisted till follow up.

Uso de un nuevo implante: U-Force N6 a nivel L5 S1 para evitar la inestabilidad lumbar tras discectomía simple / Using a new implant: U-Force N6 to level L5 S1 to avoid lumbar instability after single discectomy

Resumen: Introducción: Estudio prospectivo en pacientes afectos de hernia discal lumbar L5 S1 tratados mediante la U-Force interespinosa N6. El espaciador interespinoso denominado "U" está realizado en titanio y es colocado entre las apófisis interespinosas. Material y métodos: 50 pacientes operados de hernia discal lumbar fueron evaluados; 25 pertenecían al grupo U-N6 y 25 sólo fueron tratados con microcirugía. Se les realizó valoración clínica y estudios radiológicos seriados. Todos los individuos tuvieron un seguimiento durante dos años (2013-2014). Resultados: Nuestro estudio revela que el uso del dispositivo fue más efectivo (estadísticamente significativo) para el retraso de la inestabilidad que sólo la técnica quirúrgica (p < 0.01). Permitió su colocación en 90% de los sujetos. Conclusión: El uso de este dispositivo retrasa el colapso vertebral y, por ende, la inestabilidad del segmento operado. Noventa por ciento de los casos del grupo N6 presentan el dispositivo a nivel de L5 S1 versus 60% del grupo histórico con otros dispositivos (2004-2011).

Abstract: Introduction: We conducted a retrospective study in patients with disc herniation and compared the results obtained in individuals treated with the U device N6 with those acquired in patients treated without any device. The U device is a titanium alloy implant that is placed between the spinous processes. Material and methods: In a cohort of 50 patients with degenerative lumbar disc, 25 underwent surgical treatment in which the U device was placed and 25 control individuals were treated with discectomy alone. Patients underwent serial follow-up evaluations, and radiographic assessment was used to determine the outcome. Up to two years of follow-up data were obtained in all patients (2013-2014). Results: Statistically significant improvement was seen in patients treated with the coflex device in the management of lumbar disc degeneration to avoid lumbar instability in the future (p < 0.01). It allowed its placement in 90% of the patients. Conclusions: Our study shows that the coflex device was more effective than the discectomy group in the management of lumbar instability. Ninety percent of the cases of the N6 group present the device at L5 S1 versus 60% of the historical group with other devices (2004-2011).

Microdiscectomia lombar: acessos interlaminar e intertransverso com uso de afastador de Caspar tubular cilíndrico e dreno de Penrose como auxiliar no afastamento da musculatura ­ estudo de 502 casos / Lumbar Microdiscectomy: Interlaminar and Intertransverso Access using Tubular Retractor Caspar Cylindrical and Penrose Drain as an Aid in Muscular Retraction ­ Study of 502 Cases

Os autores fazem uma revisão da literatura abordando conhecimentos neuroanatômicos da raiz e do gânglio da raiz dorsal. Descrevem a técnica para os acessos interlaminar e intertransverso com o uso de afastador de Caspar tubular cilíndrico e dreno de Penrose como auxiliares no afastamento da musculatura. Basearam-se em 502 casos operados em 25 anos. O objetivo deste trabalho é descrever uma técnica com incisão pequena na pele, baixa agressividade para as estruturas anatômicas, sem perda funcional da musculatura paravertebral, campo cirúrgico amplo, facilidade de execução com as duas mãos, alta hospitalar precoce em torno de 24 horas e baixo custo.

The authors review the literature addressing neuro-anatomical knowledge of the root and root ganglion dorsal. Describe the technique for the interlaminar and intertransverso access using tubular retractor Caspar cylindrical Penrose drain as an aid in muscular retraction. Based-seem 502 cases operated in 25 years. The objective of this paper is to describe a technique with small skin incision, low aggressiveness anatomical structures without functional loss of paraspinal musculature, broad surgical field, easy work with both hands, high early hospital about 24 hours and low cost.